Maria Vejar: College of Nursing DNP Student Conducts Research in Seniors Clinic

Nurse Practioner finds niche in geriatrics

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​A deep love for her grandparents led Maria Vejar into caring for the elderly.

“My grandparents inspired me,” she recalls. “They were very active and had a wonderful sense of humor. They loved living.” Observing how her grandparents aged and dealt with their medical needs—as well as the quality of care her mother modeled as a nurse—led Vejar to prefer the senior population, even after she did the required rounds of pediatrics, medical-surgical, etc. in her nursing training. “I found my niche in geriatrics.”

Vejar has been a certified geriatric nurse practitioner since 1997. Now she’s about to complete requirements for her doctorate (DNP). She’s worked in CU’s Seniors Clinic for 11 years and is a full-time senior instructor in the CU’s School of Medicine. The clinic’s average patient is 80 years old. Understanding the elderly population and their needs, the clinic schedules 40-minute visits (rather than the typical 20-minute time slot).

Patients, although they are for the most part active and independent, have multiple health issues. “They are silent warriors with what they deal with on a regular basis,” Vejar reflects.

A team of medical professionals comprises the clinic staff, including physicians, physician assistants, nurse practitioners, RNs, social workers and pharmacists.

The University of Colorado at the Anschutz Medical Campus offers a couple of programs pertinent to seniors. The Center on Aging sponsors a free, monthly educational discussion aimed at helping seniors better understand aging. Called 1st Saturday, the program welcomes the community to learn about dementia, falls, pain and palliative care, oral health, exercise and much more.

The Seniors Clinic has a similar opportunity through an invitation-only gathering on the second Friday of the month. A group of 10 to 20 patients discusses health topics important to them. A physician and social worker facilitate the session. Sometimes nursing or medical students drop in. “People find they learn from each other,” Vejar observes.

Her doctoral work includes a quality improvement project—on medication reconciliation and management. It addresses the real problem of exactly what medications—prescribed and over-the-counter (OTC)—seniors are taking and how those medications interact with each other in the elderly body. In fact, most clinics have not done a good job of tracking drug intake because it takes time to identify and record drug use. Vejar’s goal was to move the clinic from 64 percent medication reconciliation (that is, a fully reconciled medication list at each clinic visit) to 90 percent or above.

In nine months, the rate rose to 96 percent reconciliation. (That is, 96 percent of the time, professionals were able to review and verify the nature and dose of all medications taken, including prescription and OTC, at each patient visit.) One benefit to the improvement: by asking patients to bring in all medications, including OTC drugs, patients increased their understanding of the role different drugs play in health.

Vejar presented these findings at geriatric grand rounds in March 2012 and at her DNP capstone course in May. “Not only were providers and staff educated that we had a problem,” Vejar says, “but we educated the patients as well.”

Since she’s a certified nurse practitioner, what led Vejar to take the extra effort, time and cost to pursue a doctorate? Her boss, Dr. Robert Schwartz who runs the Seniors Clinic, encouraged her. She had family and financial support. As a result, Vejar was surprised to discover “the program ended up changing my focus far more than I thought it would. As nurses, we have a responsibility to advance to the highest degree we can. Not everyone may want a doctorate, but it’s important to advance to the level to which you are capable. It raises the bar and makes us better nurses, preceptors and providers.”

Vejar also sees an advantage in studying at CU. The College of Nursing was the first in the country to develop the nurse practitioner program. “Getting my terminal degree here is like coming full circle,” Vejar says, back to where the NP began. “The professors are extraordinary. The program fits beautifully with my schedule. Most of it is online. I’m in awe of the people I’ve met, not only teaching the classes, but the students.”

She also sees the benefit of the interdisciplinary nature of the Anschutz Medical Campus. “It’s magnificent,” she says. “I get to work with pharmacists, social workers, doctors, physician assistants and nurses. I often refer to the dental school. All the academic areas are extraordinary.”

Vejar also has a keen interest in geriatric care in rural areas, primarily because she has seen the care (or lack thereof) her parents receive in their rural community. Corollary areas of interest are grief and loss. “As seniors live longer, they may lose not only a partner, but also a child,” Vejar observes.